Failure to Timely Monitor and Treat Constipation Leading to Severe Fecal Impaction
Penalty
Summary
The facility failed to provide timely monitoring and treatment for a resident with a history of constipation who had not had a bowel movement for several days and was experiencing pain. Despite the resident's repeated complaints of pain and lack of bowel movements, staff did not perform adequate assessments, did not notify the physician of the resident's change in condition, and did not document interventions or their effectiveness. The resident received PRN medications for constipation that were documented as ineffective, but no further action was taken, and the resident's pain continued to escalate without appropriate response from nursing staff. Multiple staff members, including CNAs and nurses, were made aware of the resident's ongoing pain and requests for help, but failed to conduct timely assessments or escalate care. The resident's family ultimately intervened after hearing the resident in distress, leading to the resident being sent to the hospital, where a severe fecal impaction was discovered, requiring operative intervention under anesthesia. The medical record lacked documentation of physical assessments, physician notifications, and timely interventions in response to the resident's symptoms and ineffective medications. Additionally, the facility failed to implement an effective protocol for ongoing monitoring of bowel management for multiple residents. Reviews of other residents' records revealed delays in administering interventions for constipation, lack of timely assessments, and inconsistent documentation of bowel movements and physician notifications. The facility's bowel management program was not consistently followed, resulting in delayed care and potential harm to residents with constipation or at risk for bowel irregularity.
Removal Plan
- Reviewed and revised a new bowel procedure/protocol in collaboration with the Medical Director.
- Educated all nursing staff on the new policy.
- Implemented the new protocol.
- Conducted a complete audit of residents' records for the need and/or continued use of Milk of Magnesia (M.O.M.) and other bowel management medications.
- Confirmed orders with the Medical Director.
- Established a process where if a resident flagged on the EMAR dashboard as not having had a BM after 72 hours, they should receive a dose of MOM.
- Required that if a resident had not had a BM by the end of that nurse's shift, the physician would be notified and report given to the oncoming nurse.
- Ensured systemic plan for education and monitoring of staff to ensure staff assessed and monitored residents for pain and change in condition, and that staff followed the facility bowel protocol.